Presentation on theme: "TRANSITION SERIES Topics for the Advanced EMT CHAPTER Trauma in Special Populations: Pregnancy 43."— Presentation transcript:
TRANSITION SERIES Topics for the Advanced EMT CHAPTER Trauma in Special Populations: Pregnancy 43
Objectives Review the incidence rates at which pregnant females are traumatized. Review normal anatomy and physiology. Discuss complications that can occur from trauma in pregnant females. Review assessment findings and discuss treatment strategies.
Introduction Trauma can at times be complicated. The pregnant patient can be one of those complications as the Advanced EMT must care for two patients now. Everything that the Advanced EMT does for the mother affects the baby that is yet unseen.
Epidemiology Trauma occurs in about 6%-7% of pregnancies, and is the leading cause of death for pregnant women. MVCs account for 50% of injuries. 41% of fetuses die when the mother suffers a life-threatening injury. Up to 17% of pregnant women are victims of abuse.
The anatomy of pregnancy
Pathophysiology Complications of Trauma: Uterine Contractions –Most common complication. –May progress to preterm labor. –Monitor quality of contractions.
Pathophysiology (cont’d) Complications of Trauma: Preterm Labor –Occurs before 38 th week of gestation. –Fetus viable following the 24 th week of gestation.
Pathophysiology (cont’d) Complications of Trauma: Spontaneous Abortion –Occurs before the 20 th week of gestation. –Common findings include abdominal pain, cramping, vaginal bleeding.
Pathophysiology (cont’d) Complications of Trauma: Abruptio Placentae –Results mostly from blunt trauma. –Separation of placenta from uterine wall. –With or without external hemorrhage. –Abdominal pain, uterine tenderness, vaginal bleeding, hypovolemia.
Pathophysiology (cont’d) Complications of Trauma: Uterine Rupture –Due to blunt force trauma. –Most fatal complication to mother and fetus. –Presents with maternal shock and palpable fetal parts in abdomen.
Pathophysiology (cont’d) Complications of Trauma: Penetrating Trauma –Great fetal risk of injury. –Penetration in upper abdomen results in bowel and abdominal injuries. –Penetration in lower abdomen results in direct fetal injuries and death.
Pathophysiology (cont’d) Complications of Trauma: Pelvic Fractures –Result from blunt trauma to abdomen. –May sustain significant hemorrhage. –Bladder, urethral, intestinal injuries –25% fetal mortality rate
Pathophysiology (cont’d) Complications of Trauma: Hemorrhage and Shock –Can result from most any injury previously discussed. –Frequent cause of death to mother and fetus. –Mother may lose 30% blood volume before becoming symptomatic.
Pathophysiology (cont’d) Complications of Trauma: Cardiopulmonary Arrest –Significant threat to fetus. –Poor likelihood of fetal survival with maternal death. –Continue with resuscitative efforts if mother in 3 rd trimester.
Assessment Findings Follow normal assessment steps. Pay attention to abdomen and uterus –Uterus should be palpable above iliac crest after the 12 th week. It will continue to grow and move upwards throughout the pregnancy. –When contractions occur uterus should feel taut and round; if asymmetric, consider uterine rupture.
Assessment Findings (cont’d) Questions should include: –Due date, gestational age, fetal movement, contractions, previous obstetric history.
Emergency Medical Care Spinal immobilization considerations –Tilt backboard to left side after 20 weeks of gestation. Assess and maintain the airway. –Vomiting common with pregnant mothers.
Emergency Medical Care (cont’d) Determine breathing adequacy. –High-flow via NRB with adequate breathing. –High-flow via 10–12/min if inadequate.
Emergency Medical Care (cont’d) Assess circulatory components. –Check pulse, skin characteristics. –With vaginal bleeding, absorb blood but don't pack vagina. –Control external major bleeds normally. –Start at least one large-bore IV en route to the hospital and run fluids according to patient presentation or local protocol.
Emergency Medical Care (cont’d) Perform a visual exam of vagina. –Assess for crowning or bleeding Provide full immobilization. Treat any minor injuries, time allowing.
Case Study You are dispatched to a single car MVC, in which the lone driver lost control on a wet road and struck a utility pole at a significant speed. FD is on scene still trying to disentangle the patient from the car. As you draw toward the car window, you can see a young adult female who is unresponsive and obviously pregnant.
Case Study (cont’d) Based on the scene size-up, what are some conditions you suspect the patient may have? What will be your assessment approach to her?
Case Study (cont’d) Scene Size-Up –Scene safe from personal hazards. –Standard precautions taken. –Patient extricated from auto. –22–24-year-old female, 160 lbs, 3 rd trimester. –MOI is blunt trauma from frontal MVC. –Consider notifying aeromedical transport for transport to trauma facility.
Case Study (cont’d) Primary Assessment Findings –Patient moans to noxious stimuli. –Airway open, breathing shallow, breath sounds present bilaterally. –Carotid and radial pulses present & tachycardic.
Case Study (cont’d) Primary Assessment Findings –Peripheral skin cool and slightly diaphoretic. –Hemorrhage to proximal femoral shaft fracture that is open.
Case Study (cont’d) Is this patient a high or low priority? Why? What interventions should be provided at this time?
Case Study (cont’d) Medical History –Unknown other than patient is pregnant Medications –Unknown Allergies –Unknown
Case Study (cont’d) Pertinent Secondary Assessment Findings –Patient is unresponsive to noxious stimuli now. –B/P 82/60, heart rate 140, respirations 32. –Physical assessment reveals abrasions and contusions to lower abdomen. –LLQ and RLQ both firm to palpation.
Case Study (cont’d) What are two different explanations as to why the mother has a change in mental status? How would you characterize the blood flow and oxygenation to the fetus at this time?
Case Study (cont’d) What patient positioning modifications will you make for this pregnant patient? If the patient starts to improve, what would be the expected findings for: –Mental status –Heart rate –Skin findings
Case Study (cont’d) Care provided: –Patient cervical spine manually immobilized. –High-flow oxygen via mask initially, PPV while en route due to respiratory failure. –Full spinal immobilization, board tilted to left.
Case Study (cont’d) Care provided: –Patient transported and large-bore IV inserted. –IV fluids to increase blood pressure. –Patient reassessed during transport without change in condition, hemorrhage controlled.
Summary The Advanced EMT must remember that the pregnant patient may have unique injury patterns and presentation findings following trauma. The care provided must equally support the mother's immediate needs as well as promote good perfusion, oxygenation, and nutrient delivery to the fetus.